Kuehhas Franklin E, Naegele Ralph, Eckersberger Elisabeth, Margreiter Markus, Herwig Ralf, Kazzazi Amir, Djavan Bob
Department of Urology, University of Vienna, Austria.
Can J Urol. 2011 Aug;18(4):5811-8.
To compare the commonly used 0-1 pad definition of urinary continence for postoperative functional outcome after radical prostatectomy and the correlation with self-reported urinary continence and to determine whether a patient questionnaire can deliver more accurate continence status rates.
We evaluated a cohort of 873 men who underwent radical prostatectomy (RP) at the General Hospital in Vienna between 1998 and 2006. Patients were surveyed with a questionnaire regarding their postoperative outcome and postoperative urinary incontinence. Baseline and pathological factors were examined to determine whether or not they had an impact on the continence status.
A total of 65.2% of men (n = 337) reported themselves to be continent, in contrast 85.1% were continent if the pad definition was applied. Of those using no pads, 93.4% considered themselves continent, while 24.5% of patients using one pad/day did. Overall, 86.5%, 9.8% and 3.7% of continent patients regained continence within 6 months, 6 to 12 months and after 1 year of RP, respectively. A total of 71.5% of men under 65 years old reported full urinary continence, while only 57.0% of men older than 65 considered themselves continent. Men < 65 years recovered full urinary control significantly faster than men older than 65 years- 3.6 versus 4.7 months. Neurovascular bundle resection has a negative effect on continence.
The ultimate continence status should be measured with self-administered disease specific questionnaires at 24 months after RP, as it differs from standard physician reported methods. Age and neurovascular bundle resection are variables affecting continence. We believe that patients' subjective reports of their continence are crucial and that multiple outcomes should be objectively measured. Therefore we suggest that validated questionnaires dealing with the patients' perspective postoperatively should be included in routine follow up.
比较根治性前列腺切除术后常用的0-1片垫定义对术后功能结局的影响以及与自我报告的尿失禁的相关性，并确定患者问卷是否能提供更准确的尿失禁状态发生率。
我们评估了1998年至2006年期间在维也纳总医院接受根治性前列腺切除术（RP）的873名男性队列。用问卷对患者进行术后结局和术后尿失禁情况的调查。检查基线和病理因素以确定它们是否对尿失禁状态有影响。
共有65.2%的男性（n = 337）报告自己为尿失禁，相比之下，若采用片垫定义，尿失禁发生率为85.1%。在不使用片垫的患者中，93.4%认为自己为尿失禁，而每天使用一片垫的患者中这一比例为24.5%。总体而言，分别有86.5%、9.8%和3.7%的尿失禁患者在RP术后6个月内、6至12个月以及1年后恢复尿失禁。65岁以下的男性中共有71.5%报告完全尿失禁，而65岁以上的男性中只有57.0%认为自己为尿失禁。65岁以下的男性恢复完全尿控的速度明显快于65岁以上的男性——分别为3.6个月和4.7个月。神经血管束切除术对尿失禁有负面影响。
根治性前列腺切除术后24个月应使用针对疾病的自我管理问卷来衡量最终的尿失禁状态，因为其与标准的医生报告方法不同。年龄和神经血管束切除术是影响尿失禁的变量。我们认为患者对其尿失禁的主观报告至关重要，并且应该客观地测量多种结局。因此，我们建议在常规随访中纳入从患者角度出发的经过验证的问卷。
